II. Epidemiology
- Rare in United States due to Immunization (DTP, DTaP)
- However 20% of adults may be inadequate Immune Status
- Ongoing epidemic in the former USSR
III. Pathophysiology
- Causative Organisms
- Corynebacterium diphtheriae is a non-spore forming Gram Positive Rod
- Other Corynebacterium species (ulcerans, pseudotuberculosis) may be rarely transmitted from animals to humans
- Diphtheria Toxin (Bacteriophage encoded, not carried by some strains of C. Diphtheriae)
IV. Symptoms
- Sore Throat
- Dysphagia
- Weakness
- Malaise
V. Signs
- Toxic appearance
- Low grade fever
- Tachycardia (out of proportion to fever)
- Pharyngeal erythema
- Gray-white tenacious exudate or "pseudomembrane" adheres to posterior pharynx
- Composed of white cells, Fibrin, necrosed epithelial cells and Diphtheria cells
- Nidus of infection, source of Diphtheria neurotoxic and cardiotoxic exotoxin which is absorbed systemically
- Occurs at Tonsillar Pillars and posterior pharynx
- Leaves focal hemorrhagic raw surface when removed
- Cervical Lymphadenopathy
VI. Differential Diagnosis
- Vincent's Angina (Trench Mouth)
- Also shows pseudomembrane formation
- Pharyngitis
VII. Labs
- Complete Blood Count (CBC)
-
Throat Culture and nasal culture
- Positive for Corynebacterium organisms (but results are typically delayed for days)
- Samples are plated
- Potassium tellurite agar
- Corynebacterium diphtheriae colonies become gray-black in the first day)
- Loeffler's Coagulated Blood Serum Media
- Sample incubated for 12 hours, then evaluated under methylene blue stain for Gram Negative Rods
- Potassium tellurite agar
- Further organism identification is via several methods including PCR, and specific toxin testing
- Not all C. diptheriae strains express Bacteriophage encoded toxin production
VIII. Management
- Droplet precautions
- Empiric treatment in suspected cases (do NOT delay treatment until culture confirmation)
- Diphtheria antitoxin (Equine serum from CDC)
- Scratch test before use
- Inactivates circulating toxin before it damages heart and nerve tissue
-
Antibiotics for 14 day duration
- Erythromycin 20 mg/kg/day divided every 6 hours IV or
- Penicillin G 50,000 units/kg up to 1.2 MU/day IV every 12 hours, then transition to Penicillin VK when able
- Culture and Treat contacts
- Procaine Penicillin for 1 dose OR
- Erythromycin for 7-10 days
IX. Prognosis
- Without treatment, Diphtheria has a mortality rate as high as 50%
- With treatment, mortality may still approach 5-10%
X. Prevention
- DTP Vaccination or DTaP Vaccination
- Also administer to recovered patients (infection does not ensure Immunity)
XI. Resources
- CDC - Diphtheria
XII. References
- Sanford Guide, accessed on IOS 12/29/2019
Images: Related links to external sites (from Bing)
Related Studies
| Definition (NCI_CDISC) | Any bacterial organism that can be assigned to the species Corynebacterium diphtheriae. |
| Definition (NCI) | A species of aerobic or facultatively anaerobic, Gram-positive, coryneform, pleomorphic bacilli assigned to the phylum Actinobacteria. This species is nonmotile, non-spore forming, catalase positive, non-lipophilic, produces diphtheria toxin which inhibits elongation factor 2 (EF-2) thus preventing protein synthesis, forms polar granules, and is cultured in Loeffler's serum in a low iron environment or on tellurite agar. C diphtheriae is commensal in the skin and nasopharynx, but toxin producing strains are pathogenic to humans causing diphtheria; both an antitoxin and vaccine are available for disease prevention. |
| Definition (MSH) | A species of gram-positive, asporogenous bacteria in which three cultural types are recognized. These types (gravis, intermedius, and mitis) were originally given in accordance with the clinical severity of the cases from which the different strains were most frequently isolated. This species is the causative agent of DIPHTHERIA. |
| Definition (CSP) | species of gram positive, asporogenous bacteria in which three cultural types are recognized; these types (gravis, intermedius, and mitis) were originally given in accordance with the clinical severity of the cases from which the different strains were most frequently isolated; the causative agent of diphtheria. |
| Concepts | Bacterium (T007) |
| MSH | D003353 |
| SnomedCT | 5851001 |
| LNC | LP16683-2, MTHU006922 |
| English | Corynebacterium Diphtheriae, CORYNEBACT DIPHTHERIAE, C. diphtheriae, Corynebacterium diphtheriae (Kruse 1886) Lehmann and Neumann 1896, Bacillus diphtheriae, Bacterium diphtheriae, Microsporon diphthericum, Microsporon diphtheriticum, Mycobacterium diphtheriae, Pacinia loeffleri, CORYNEBACTERIUM DIPHTHERIAE, Diphtheria bacillus, Klebs-Loeffler bacillus, Corynebacterium diphtheriae (organism), Corynebacterium diphtheriae |
| Swedish | Corynebacterium diphtheriae |
| Czech | Corynebacterium diphtheriae |
| Finnish | Corynebacterium diphtheriae |
| Russian | KORINEBAKTERII DIFTERII, PALOCHKA LEFLERA, CORYNEBACTERIUM DIPHTHERIAE, BACILLUS DIPHTHERIAE, BACTERIUM DIPHTHERIAE, MICROSPORON DIPHTHERICUM, PACINIA LOEFFLERI, КОРИНЕБАКТЕРИИ ДИФТЕРИИ, ПАЛОЧКА ЛЕФЛЕРА |
| Polish | Corynebacterium diphtheriae, Maczugowce błonicy |
| Norwegian | Corynebacterium diphtheriae |
| Spanish | Corynebacterium diphteriae, Bacilo diftérico, Corynebacterium diphtheriae (organismo), bacilo de Klebs - Loeffler, Corynebacterium diphtheriae |
| French | Bacille diphtérique, Corynebacterium diphtheriae |
| German | Bacterium diphtheriae, Corynebacterium diphtheriae, Diphtherie-Bakterium |
| Italian | Corynebacterium diphtheriae |
| Dutch | Corynebacterium diphtheriae |
| Portuguese | Corynebacterium diphtheriae |
Ontology: Diphtheria (C0012546)
| Definition (MEDLINEPLUS) |
Diphtheria is a serious bacterial infection. You can catch it from a person who has the infection and coughs or sneezes. It usually affects the nose and throat and causes a bad sore throat, swollen glands, fever, and chills. But if it is not properly diagnosed and treated it produces a poison in the body that can cause serious complications such as heart failure or paralysis. The diphtheria, pertussis and tetanus (DPT) vaccine can prevent diphtheria, but its protection does not last forever. Adults should get another dose, or booster, every 10 years. Diphtheria is very rare in the United States because of the vaccine. Centers for Disease Control and Prevention |
| Definition (NCI) | A Gram-positive bacterial infection caused by Corynebacterium diphtheria. It usually involves the oral cavity, pharynx, and nasal cavity. Patients develop pseudomembranes in the affected areas and manifest signs and symptoms of an upper respiratory infection. The diphtheria toxin may cause myocarditis, polyneuritis, and other systemic effects. |
| Definition (MSH) | A localized infection of mucous membranes or skin caused by toxigenic strains of CORYNEBACTERIUM DIPHTHERIAE. It is characterized by the presence of a pseudomembrane at the site of infection. DIPHTHERIA TOXIN, produced by C. diphtheriae, can cause myocarditis, polyneuritis, and other systemic toxic effects. |
| Definition (CSP) | localized infection of mucous membranes or skin caused by toxigenic strains of Corynebacterium diphtheriae; it is characterized by the presence of a pseudomembrane at the site of infection; diphtheria toxin, produced by C. diphtheriae, can cause myocarditis, polyneuritis, and other systemic toxic effects. |
| Concepts | Disease or Syndrome (T047) |
| MSH | D004165 |
| ICD9 | 032.9, 032 |
| ICD10 | A36 , A36.9 |
| SnomedCT | 154299004, 186349009, 187323007, 3739008, 397428000, 276197005 |
| LNC | LA10452-3 |
| English | Diphtheria, Diphtherias, Diphtheria, unspecified, [X]Diphtheria, unspecified, diphtheria, diphtheria (diagnosis), Diphtheria NOS, Diphtheria [Disease/Finding], Diphtheria NOS (disorder), Corynebacterium diphtheriae infection, [X]Diphtheria, unspecified (disorder), Infection due to Corynebacterium diphtheriae, Diphtheria (disorder), Infection due to Corynebacterium diphtheriae (disorder), diphtherial; infection, infection; Corynebacterium diphtheriae, infection; diphtherial, Corynebacterium diphtheriae; infection, Diphtheria, NOS |
| Dutch | difterie, niet-gespecificeerd, Corynebacterium diphtheriae-infectie, Corynebacterium diphtheriae; infectie, difterisch; infectie, infectie; Corynebacterium diphtheriae, infectie; difterisch, Difterie, niet gespecificeerd, difterie, Difterie |
| French | Diphtérie, non précisée, Infection à Corynebacterium diphtheriae, Diphtérie |
| German | Diphtherie, unspezifisch, Corynebacterium diphtheriae-Infektion, Diphtherie, nicht naeher bezeichnet, Diphtherie |
| Italian | Infezione da Corynebacterium diphtheriae, Difterite non specificata, Difterite |
| Portuguese | Difteria NE, Infecção por Corynebacterium diphtheriae, Difteria |
| Spanish | Infección por Corynebacterium diphtheriae, Difteria no especificada, [X]difteria, no especificada, [X]difteria, no especificada (trastorno), difteria, SAI, infección por Corynebacterium diphteriae, difteria, SAI (trastorno), difteria, difteria (trastorno), infección por Corynebacterium diphtheriae (trastorno), infección por Corynebacterium diphtheriae, Difteria |
| Japanese | ジフテリア、詳細不明, ジフテリア, コリネバクテリウム・ジフテリア感染, ｼﾞﾌﾃﾘｱｼｮｳｻｲﾌﾒｲ, ｺﾘﾈﾊﾞｸﾃﾘｳﾑｼﾞﾌﾃﾘｱｶﾝｾﾝ, ｼﾞﾌﾃﾘｱ |
| Swedish | Difteri |
| Czech | záškrt, Infekce způsobená Corynebacterium diphteriae, Difterie, Difterie, blíže neurčená, difterie, diftérie, mázdřivka |
| Finnish | Kurkkumätä |
| Russian | DIFTERIIA, ДИФТЕРИЯ |
| Korean | 디프테리아, 상세불명의 디프테리아 |
| Polish | Dyfteryt, Błonica, Zakażenie Corynebacterium diphtheriae |
| Hungarian | diphtheria, nem meghatározott, diphtheria, Corynebacterium diphtheriae fertőzés |
| Norwegian | Difteri |
